Does Medicare Cover Zepbound for Sleep Apnea?

Key Takeaways

• Zepbound is an FDA-approved prescription weight-loss drug that can be used to treat sleep apnea for those with obesity.
• Medicare may cover Zepbound for sleep apnea, but only if you have a diagnosis of moderate to severe sleep apnea, a BMI of 27 or higher, and prescription drug coverage through Medicare Part D or a Medicare Advantage plan.
• Medicare does not cover Zepbound for weight loss alone.

How Zepbound Works for Sleep Apnea

Obesity is a significant risk factor for developing OSA. That’s because extra fat deposits near the throat can narrow the airway or cause soft tissues to collapse.

Zepbound is an injectable prescription weight-loss drug that’s FDA-approved to treat obstructive sleep apnea in individuals with obesity. It works as an appetite suppressant by activating two hormone receptors, GIP and GLP-1, which regulate blood sugar, metabolism, and appetite. Clinical trials showed a reduction of breathing disruptions of more than 50% over one year.

In short, it can help some people lose weight, and for people whose obesity contributes to their sleep apnea, it can also help reduce sleep apnea symptoms.

Medicare Coverage of Zepbound for Sleep Apnea

Medicare covers Zepbound for sleep apnea, provided you also have a BMI of 27 or greater and have Medicare Part D. Medicare Part D is an optional plan that helps pay for prescription drugs, and you can either add it to your Medicare plan or have it as part of a Medicare Advantage Plan.

However, Medicare doesn’t cover drugs for weight-loss purposes only, which is why it didn’t cover Zepbound until late 2024 when it was approved to treat sleep apnea. That’s also why you’ll need a sleep apnea diagnosis to get a prescription for Zepbound and to receive Medicare coverage. 

How to Get Medicare to Cover Zepbound for Sleep Apnea

Your first step in getting Medicare coverage for Zepbound is a sleep apnea diagnosis. Sleep Doctor’s home sleep test allows you to test for sleep apnea at home and receive a diagnosis from a licensed physician. 

If your doctor decides that Zepbound should be part of your sleep apnea treatment, they’ll write a prescription. Then, you can check to make sure your particular Medicare plan covers it. Because Zepbound is FDA-approved to treat sleep apnea in patients with obesity, a BMI of 27 or higher is also required for coverage.

Medicare Plans That May Cover Zepbound

The plans that may cover Zepbound include Medicare Part D and Medicare Advantage, also known as Medicare Part C. Medicare Part D is an optional prescription drug plan. If you have or are considering signing up for Original Medicare, which includes hospital and medicare care, you can add Medicare Part D to that plan.

Medicare Advantage is a plan offered by private insurers that must comply with Medicare’s rules. It usually includes Medicare Part D drug coverage, so Zepbound is likely to be covered, but it’s important to check your specific plan to make sure.

Medicare’s Requirements for Zepbound Coverage

To cover Zepbound, Medicare requires that patients have both moderate to severe sleep apnea and a BMI of 27 or higher. Medicare isn’t able to cover Zepbound for weight loss if you don’t also have a diagnosis of sleep apnea. You also need to have either Medicare Part D or Medicare Advantage.

Additionally, your doctor will need to submit a prior authorization to Medicare, indicating the reason Zepbound being prescribed, verifying the severity of your sleep apnea, and confirming your BMI eligibility.

While Medicare proposed a rule change in late 2024 that would have expanded coverage for drugs like Zepbound to be used only for weight loss in people with obesity, the proposal was struck down in 2025, solidifying that coverage of Zepbound requires a person to also have sleep apnea.

Zepbound Cost With Medicare

Zepbound costs used to vary depending on your particular Medicare plan, but the federal government has recently made changes to lower the cost of Zepbound and other GLP-1 pharmaceuticals. Starting in 2026, Zepbound will have a fixed price of $245 a month for Medicare, and enrollees will pay a copay of about $50 a month.

Check if Your Medicare Plan Covers Zepbound

To see if your Medicare Plan covers a particular drug like Zepbound, you can check your plan’s formulary, which is a list of covered pharmaceuticals. With the federal government’s recent change to GLP-1 coverage and pricing, those with Medicare Part D and Medicare Advantage should receive coverage for Zepbound, but it’s always a good idea to confirm with your particular plan.